Provider Demographics
NPI:1558957787
Name:WHITEHEAD, DANIEL JACOB (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JACOB
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 900
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6331
Mailing Address - Country:US
Mailing Address - Phone:501-552-3592
Mailing Address - Fax:501-552-4129
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 900
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6331
Practice Address - Country:US
Practice Address - Phone:501-224-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213312363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care